4th degree tear. Struggling.

[newmumtotwo]

Hi, I'm new to this board, and am sorry to begin with such a downbeat post. I think I am just looking for info & support really.

Had twins nearly 9 months ago. Both were vaginal deliveries but twin one was face/brow presentation and forceps delivery. Twin two followed four minutes (and some pushes!) later. Somewhere in amoungst all this I suffered a fourth degree tear and lost 2.5 litres blood.

I am struggling to get over all this. Now I have to reply to my boss about going back to work and I just don't know what to do. My tear is still symptomatic (minimal bowel control, no wind control, beginnings of bladder problems) and long term does not look good for bowel continence (have seen specialist). Thankfully I am seeing a fantastic physio who specialises in continence issues - she was first to suggest various products to help me (i.e. spongey anal plugs, pads).

Had a birth debriefing, but still have questions. Tear occurance is not documented in my notes, cause of bleeding is not listed. Also, hospital "forgot" to arrange any follow up checks for the tear and I ended up scared and embarrased self-referring to my GP.

I feel butchered and violated. Is this normal? Am I just unlucky or should I think about pursuing action against hospital (as it seems I will not be able to return to full time work - how do I earn money?).

Thank you if you have read this far - any advice appreciated, I have posted on other sites so apologies if you have already read my long-winded story!

This as well

Hi, I went through all this seven years ago. It was shit, if you'll excuse the pun. I've had physio, surgery and also tried to sue the hospital (not easy and not necessarily something I'd recommend.) My life is pretty good now, but for a while it was vile. I totally understand how you feel, it is exactly how I felt back then. If I can help you in anyway please do not hesitate to ask. Feel free to CAT me, also, if you would like to talk more privately. xxx

What a truly horrible experience. Very sorry for you. I would definately want some answers. I would demand an explanation from the hospital, seek counselling, and talk to a solicitor.

I would also name the hospital on here so that others who may be pregnant and due to go there are forwarned.

And, of course, congratulations on your twins and welcome to mumsnet.

newmumoftwo - I am so sorry to hear of what has happened to you. Please ask to have an appointment with your consultant to go through what happened and why it has not been documented. If it hasn't been documented that is a serious concern. Was the terar repaired properly in theatre? There should be an operation note. If it wasn't you actually have grounds to sue.

On the employment front, you resume to work but immediately get signed off sick. You do not need to be well to return.

Newmumoftwo

I read your post with interest as I ended up in a similar situation myself. Following a failed ventouse then forceps delivery I was told I had a 2nd degree tear. After months of bowel problems I was finally referred to a Colorectal surgeon. I had a sphincter repair op 6 weeks ago and have a temporary colostomy. The hospital misdiagnosed my tear and did not repair it properly at the time. I tried pelvic floor excersises with a machine with biofeedback with no improvement prior to my referral. I was unable to return to work full time and have had my earnings more than halved in the last year. If you haven't done it already I would suggest being referred to a Colorectal surgeon so that they can do an anal ultrasound (to examine your muscle). I was told by my surgeon that physio would make no difference as the muscle was torn through and that I had a bad 3rd degree tear. I am going to pursue legal action against the Hospital and already have a copy of my notes. The lack of information in your notes suggest you may have a good case but be sure that you feel strong enough in yourself to go forward with it and you have 3 years in which to do so. Good Luck. X

Oh Newmum, I do feel for you. I had a similar experience when my DS was born just over three years ago. I had a very, very long labour (almost a week) with a spinal block and forceps at the end - he was face to pubes and no amount of pushing was going to get him out. I had a big episiotomy which tore right into my anus. The fourth degree tear went through one of my anal sphincters - the one over which there's no voluntary control - and I was left with a rectovaginal fistula, so essentially I was faecally incontinent. I fully realised this on about day four and rang to talk to the obstetrician who had delivered DS. She arranged for me to see a physiologist for an ultrasound, to identify the extent of the damage, and a colorectal surgeon, to talk about strategies for repair. She also referred me for physiotherapy which wasn't much use at that stage as even if I worked on my pelvic floor everything was still going to come out of my fanjo (sorry if that's TMI!).
Fortunately I have very regular bowels so I was almost always able to go first thing in the morning, jump in the shower and wash, and then get on with my day. I went back to work after a year, as I had planned, but I was mentally very fragile about the whole thing. Actually in some ways going back to work, and not going to mother-and-baby events so much, was a relief. I had found it very difficult to talk to other mothers about their births - particularly those who got all rosy-visioned about their "lovely experiences". I was furiously jealous of women who'd had decent births, and just furious with the hospital, with the midwives, with the obstetricians, with everybody.
The colorectal surgeon's advice was that although he could repair the fistula, in order to give the repair the best possible chance of healing well, he would need to defunctionalise my bowel. That basically means putting in a colostomy, so when DS was 18 months old I had a temporary colostomy installed. The surgeon could have done the repair at the same time but his advice was that dealing with a new colostomy and a potentially very uncomfortable repair site would be difficult. So I had the repair done a couple of months after the colostomy - I then had the colostomy reversed a couple of months after that once the surgeon was confident the repair had healed well. Finally, I had more physio as my bowel control was pretty hopeless. It is much better now - my poor old bladder is another matter!
However, none of this addressed my mental state. What was really helpful was sessions with the PALS staff - one introductory one, then a follow-up one with a midwife who went through my notes and explained in detail exactly what had happened and how all the decisions had been made. The most helpful session was the final one, where the consultant obstetrician who had been in attendance (the registrar had actually delivered DS) spent two hours with me and went through my notes in great detail. The thing that helped me more than anything was that the first thing he said, after saying hello and shaking my hand, was how very sorry he was about what had happened.
Believe me, I spent a lot of time thinking about taking the hospital to court. However, once I had talked to the consultant obs and he had explained exactly why he had made the decisions he had about my care, I felt much less angry. I also talked to several lawyer friends, none of whom were at all in favour of going to law about it. In retrospect, I think I would mainly have been motivated by a desire to punish the hospital for leaving me in such a mess. My lawyer friends felt that I might well have a case but that the process of going to law would not actually make me feel any better, which was what I really needed.
HOwever, the whole process must have cost the Trust an absolute fortune - and I can't help thinking that a nice neat C-section would have been a lot quicker, cheaper and less ghastly for all concerned. However, with my luck, they probably would have managed to cock that up too ...
Anyway, the point of this very longwinded post is to say, you're not alone. There is help out there - do contact your local equivalent of PALS - and it sounds like you have lucked out with your physio. Talk to whoever is in charge of personnel matters at work about extending your maternity leave or going over to sick leave - you may well not be in a fit state to return - but you could also think about a phased return.
Let me know if you want to discuss anything by e-mail.

You poor thing - I really sympathise with you.

I had DD in early Feb and am suffering from similar, although not quite such bad, problems as you. I have just been to see a consultant independently as I felt as though I was getting absolutely nowhere with the hospital where I delivered. Despite giving me news I'd hoped not to hear, a re-stitch is probably the only solution, it's made me feel much more positive and less angry with those who did the initial fix.

I'd also thought about the legal route, it's a very personal thing but I've decided against it for the moment. I feel I've spent enough of DD's life so far feeling traumatised about the birth experience and its aftermath, and want to try and get over this and make the most of the maternity leave I've got left.

I really hope that physically things improve for you soon and your employers are sympathetic

Thanks all for the info - it has really helped me to know I am not the freak that I feel I am. I am updating this in case anyone else has a symptomatic fourth degree tear but is not able to post for advice etc.

Have had a meeting with my boss and she suggested going over to sick leave straight from maternity leave. I was dreading the meeting but she had all the info in place for me and we had a good chat about my options. I am dissapointed but very relieved to have some time to try and sort things out.

Saw the physio again today, and she is very fab! Even manages to make bad news sound not so bad. Turns out I have made progress in some areas, but none in others so back in a month for a full assesment. She has suggested this as I have only just stopped breastfeeding so this is to allow things to settle a bit rather than assesing when hormones are still wonky.

Still in limbo, but not so stressed. Thank you for all your help, will update as things go on, so others with birth injuries can get info too.

Newmum,
Have only just read this thread and can only sympathise and wish you the best.
For what it's worth, I had a second degree tear after the birth of my son two years ago however it has healed well. I was very upset with the hospital afterwards and considered a formal complaint/legal options, however I felt that this was taking up too much of my time after the birth and stopping me from bonding with my newborn so I gave up on the idea. Whatever you decide to do, I think someone earlier said that you can bring a claim years later however I recall that the deadline was quite limited so you may want to check this out in case you need to bring a future claim for loss of earnings etc.
Muminbrum, I found your post really helpful and again really feel so much for you. With my birth coming up next month, I am booked in for c/s partly because I've had two births involving trauma to the pelvic floor and didn't want to risk anything else happening as this baby has a very large head apparantly. I am beginning to get a bit nervous about the c/s (fear of the unknown), but your post has put things into perspective.

Hi Rosetip, glad to hear my tale of woe has helped put things into perspective! I think you are so right to go for a C this time - you really don't want to run the risk of the kind of damage I had, and with a planned C you should have some control over the process. I wish you well with the rest of your pregnancy and the birth; let us know how you go.

Hi all,

A quick update - I am waiting to see if I can go on sick leave (unpaid d'oh!) straight from maternity leave. So at least that is work sorted for the moment.

I know it is different for everyone, but here are the main things I have found helpful so far - I hope someone else may find some of this some use:

1. Getting a referral to a continence specialist physio - invaluable for reassurance, support and honest advice about how to manage symptoms and products available to help with this. Also useful for checking which if any exercises can assist optimal recovery.

1. Getting a referral to a colorectal surgeon for specific testing of the anal sphincters to assess extent of damage & explain likely path of recovery/options if recovery is not likely to continue. I can't remember the correct name, but the main test is an anal-ultrasound. Also sphincter pressure testing using a probe to assess sphincter function. The two test results allow you to be given a complete picture of damage and likely recovery.

1. Coloplast Anal Plugs - available on prescription in some regions. They are made of a spongy material, look like tampons but expand when inserted to form a soft plug. They are a perfect aid for loss of control of flatus as the sponge disperses at least the noise accompanying this. Not the most comfortable but have meant the difference between isolation and occasional social contact for me! Physio told me about them but check with the continence advisor at your GP practice to see if they are available/suitable for you. Not suitable for IBS type spasms.

1. http://www.bbc.co.uk/radio4/womanshour/02/2006_45_fri.shtml Very useful info from a nurse and a previous sufferer of faecal incontinence. Info regarding causes & treatment options.

Hope this helps someone else and thank you all so much for your replies, I appreciate it xxx

newmumtotwo,

I've recovered from my second degree tear 3 years ago, but I'm sure your advice will be very useful to all the mums going through this type of injury at the moment.

What did you decide to do about the legal route? You will be on unpaid sick leave for an uncertain amount of time which is hardly ideal.

I am a solicitor and used to deal with med neg cases, but in England, and the legal system is different in Scotland. It may still be worth taking some advice as lots of solicitors offer free first sessions in order to assess your case (eg was there negligence, was it repaired properly, what happened to the notes), and I do recall in my own case that the deadline was a matter of months and not years.

In my own case, I decided not to pursue the hospital simply because I wasn't emotionally ready and it was preventing me from bonding with my son. I'm sure that there was negligence involved on the part of the midwife, who ignored my pleas to seek help from the doctors despite a long and difficult second stage (my own notes were very dodgy with parts scribbled out in between when I viewed them at the hospital and when they were later sent to me at home and now "lost" by the hospital but that's another story).

However I was never in a loss of earnings type situation and on a practical level this makes all the difference. It's not just about punishment, but also your financial security.

I have to get a Overlapping Sphincteroplasty done after my daughters birth , i am so scared anyone have information on this surgery is it worth it ??